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Home
About Us
Summer Camp
After School
Additional Programs
Galleries
Contact
2018 Summer Camp Registration Form
Full Name
Name
*
Address
Address
City
Province
- Please Select -
ON
QC
NS
NB
MB
BC
PE
SK
AB
NL
NT
YT
NU
Postal Code
Personal
Home Phone
*
Age
Date of Birth (dd/mm/yy)
Email Address
*
Choose Week(s)
July 3rd-6th
July 9th-13th
July 23rd-27th
July 30th-3rd August
August 7th-10th
August 13th-17th
August 20th-25th
August 27th-31st
Mother’s Info
Mother's Name
Use as primary contact
Mother's Phone
Mother's Business
Mother's Cell
Father’s Info
Father's Name
Use as primary contact
Father's Phone
Father's Business
Father's Cell
Emergency Contact
Emergency Contact (if different from above)
Relationship to student
Emergency's Phone
Emergency's Business
Emergency's Cell
Health Information
Family Doctor
Family Doctor Phone
Health Card No
Health, Learning or Behavior Concerns
Yes
No
If "Yes", please give details
Does this participant carry and know how to administer his/her medication?
Other Informtion (e.g. Braces, Contact lenses etc)
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